Program Operations Manual System (POMS)

A. Introduction to CPEs

A CPE is a certified record of payments that may be used for legal purposes, including
as evidence in a court of law. CPE requests may derive from local courts, private
sector attorneys, or other entities seeking verification of benefit information (for
example, for child support enforcement cases or fraud in the Supplemental Nutrition
Assistance Program (SNAP), formerly known as Food Stamps). CPE requests are priority
cases and should be processed within 20 business days of receipt.

B. Requests for payment extracts from local courts, private sector attorneys, or other
entities

Authorization for certification of the extract (Swear Statement) (Follow the instructions
in Exhibit 5 of GN 02406.147F in this section.); and,

•

CPE (follow the format shown in Exhibits 6 and 7 GN 02406.147F in this section.)

NOTE: Exact style may vary in the different processing centers and components.

Include the following items in the correspondence:

1.

A short introductory paragraph that includes the beneficiary's name and the timeframe
covered by the extract;

2.

The payment history including:

•

Issue date of the check;

•

Exact amount of payment;

•

Explanation of the payment and payment period;

•

Extract of data relating to negotiated checks only; and

•

An explanation of any change in Hospital Insurance and Supplemental Medical Insurance
(HI/SMI)

IMPORTANT: Do not include non-negotiated checks (such as a returned check) in the extract.

3.

Annotate the check range in the “Represented Payment for” column for all prior month accruals (PMAs) and Critical Payment System (CPS) payments;

4.

An explanation of any check that represented an overpayment;

5.

If the beneficiary identification code (BIC) involved has a payee change, annotate
the dates of the change in the opening paragraph; and

6.

If a financial institution is involved, show the name and address of that institution.

Mail or fax the completed request to the regional office address listed under GN 02406.147D.

C. Processing Office of the Inspector General (OIG) requests for CPEs

OIG requests CPEs for use in prosecuting fraud cases. These extracts are acceptable
as evidence at fraud hearings in lieu of certified photocopies of checks and of testimony
by the SSA official identified as the keeper of record.

OIG submits requests for all CPEs from the corresponding Payment Service Center’s
Regional Center for Automation, Security and Integrity (CASI). You can identify these
extract requests by the CASI flag. See Exhibit 2 in GN 02406.147F. For OIG requests, CASI will:

•

distribute copies of the CPE;

•

provide the address of the OIG contact requesting the CPE; and

•

provide a reference number, if applicable.

D. PSC Regional Office Mailing Addresses for Title II CPE Requests

Mail or fax completed CPE requests to the regional office address listed in the following
chart:

E. Processing Title XVI requests for CPEs

To request Title XVI payment extracts, complete the request letter as appropriate.
See GN 02406.147F for an example of the request letter. Email (preferred), mail or fax the information
to the regional office of jurisdiction at the following address:

1. Exhibit 1 Example of Extract Cover Note

Special Agent's Name Special Agent's Title SSA/OIG 6401 Security Boulevard Baltimore, MD 21235

Dear (Agent's Name):

This is in reference to your letter dated ____________, about payments made to ___________(Recipient's Name), Social Security number _____________ for the period _____________ through _______________
. Please see enclosed extract.

If you have any further questions regarding this, please contact __________________,
Region _____, at _________________ .

In conjunction with an official investigation being conducted by this office, this
is a request for (if requesting payment extract, provide period of time covered):
__________________________________________________ _________________________

Please forward the documents identified above to _______________________ at the following
address no later than ___________

­­­­­­­­­­­­_________________________________________________

­­­­­­­­­­­­_________________________________________________

­­­­­­­­­­­­_________________________________________________

­­­­­­­­­­­­_________________________________________________

­­­­­­­­­­­­_________________________________________________

(Requester phone number: _____________________)

3. Exhibit 3 Form to Request Title II Payment Extract

Request of Title II (SSA) Benefit Payments

Send to:

Social Security Administration

Center for Security and Integrity

(Insert the Processing Center of jurisdiction address )

Requests involving all Foreign Claims and Disability Claims under Age 55

of benefits for all payments issued to the following beneficiary (ies) under the following
Social Security number(s) during the listed period:

Social Security Number (SSN):

Beneficiary (ies):

1) /

2) /

3) /

Name Own SSN:

Time Period for record of payments (only months/years involved in investigation)

(After 12/83)

From Thru:

(MM/YY) (MM/YY)

This request is part of an investigation of a possible fraud/violation of the _______________________________________________ program(s). Case Number: _______________ Name of Requester: _______________ Title of Requester: _______________ Office of Requester: _______________

Attached are the authorization for certification of extract records, certified extract
of benefits for payments issued to all beneficiaries on this account from _________through__________.

Payments certified for the period______through______were for payment via direct deposit to (Bank’s name and address), for deposit to checking/savings account number ______and identified by the routing and transit number (RTN) .

(Complete only if applicable)

(Director's Signature)

(Director’s Name)

Process Division__________ Attachments

5. Exhibit 5 Authorization for Certification of Extract from Records

Baltimore, Maryland 21241 Refer to:

(Requesting office Name and Address)

CERTIFICATION OF EXTRACT FROM RECORDS

In accordance with provisions of Title 42, United States Code (USC), Section 904,
and the authority vested in me by 42 U.S.C. 902, I hereby certify that I have legal
custody of certain records, documents, other information established and maintained
by the Social Security Administration, pursuant to Title 42, United States Code, Section
405, and that the annexed is a true extract from such records in my custody as aforesaid.

I further certify that all signatures of the Social Security Administration officials
on the annexed document(s) are genuine and made in accordance with the signers’ official
capacity

IN WITNESS WHEREOF, I have set my hand and caused the seal of the Social Security
Administration to be affixed this ________day of_______.

(Director's Signature)

(Director's Name)

6. Exhibit 6 Extract Request Format

Social Security Administration Refer to: ________

To Whom It May Concern:

The following Social Security benefits in the chart below were certified for payment
to John Doe and Jane I. Doe under Social Security claim number 000-00-0000 for the
period July 3, 1997 through June 3, 1998 and have not been reported as non-receipt
items.

Approximate Date of Payment

Amount

Represented Payment for

July 3, 1998

$604.20

June 1998 minus supplemental medical insurance premiums of $9.60

August 1, 1997

$604.20

July 1997

September 3, 1997

$604.20

August 1997

October 3, 1997

$604.20

September 1997

November 3, 1997

$604.20

October 1997

December 3, 1997

$604.20

November 1997

January 2, 1998

$604.20

December 1997

February 3, 1998

$604.20

January 1998

March 3, 1998

$638.90

February 1998

April 3, 1998

$638.90

March 1998

May 3, 1998

$638.90

April 1998

June 3, 1998

$638.90

May 1998

$7,389.20

Total amount paid to John Doe and Jane I. Doe for July 3, 1997 through June 3, 1998

Please forward the materials requested to the following name and address by__________________.

_______________________________

Phone: ___________________

Requester's Signature: _________________ Date: _______________

Thank you for your assistance in this matter.

8. Exhibit 8 Example of Title XVI Payment Extract

Social Security Administration
Regional Office ______________

I, _________________________, Social Security Administration, Region ___, hereby certify
that the following business system records of the Social Security Administration pertain
to the record of (Recipient's Name ) ________________ , Social Security number _________________ .

I further certify that the records of the Social Security Administration show that
eligibility for the Supplemental Security Income (SSI) payments as of (Date)____________ , under Section 1602 of the Social Security Act were paid to (Recipient's Name) __________________ .

Below is the record of the SSI payment(s) for the period you requested. I further
certify that the current representative payee is (Representative Payee's Name, when
appropriate) ___________________.